CROI 2019 Abstract eBook

Abstract eBook

Oral Abstracts

cytochrome P450 induction by higher EFV concentrations. Lower EFV dosing based on CYP2B6 genotype may reduce, but likely not eliminate, the impact of EFV on ENG and EE PK.

draw. Participants in the POC arm had a 3.4-fold (95% CI 2.5-4.8) higher rate of entry into decentralized ART delivery. Conclusion: POC VL testing significantly improved HIV viral suppression and retention in care in South Africa, partly by ensuring rapid receipt of VL results to PLHIV and their providers. Increasing access to POC VL testing could help to achieve the 90-90-90 targets.

Oral Abstracts

54LB EFFECT OF THE HITS INTERVENTION ON HIV TESTING UPTAKE AMONG MEN IN SOUTH AFRICA Frank Tanser 1 , Hae-Young Kim 1 , Thulile Mathenjwa 1 , Maryam Shahmanesh 2 , Janet Seeley 3 , Philippa Matthews 1 , Sally Wyke 4 , Nuala McGrath 5 , Benn Sartorius 6 , H. Manisha N. Yapa 7 , Thembelihle Zuma 1 , Anya Zeitlin 2 , Ann Blandford 2 , Adrian Dobra 8 , Till Bärnighausen 9 1 Africa Health Research Institute, Mtubatuba, South Africa, 2 University College London, London, UK, 3 London School of Hygiene & Tropical Medicine, London, UK, 4 University of Glasgow, Glasgow, UK, 5 University of Southampton, Southampton, UK, 6 University of KwaZulu-Natal, Durban, South Africa, 7 Kirby Institute, Sydney, NSW, Australia, 8 University of Washington, Seattle, WA, USA, 9 Heidelberg University, Heidelberg, Germany Background: The uptake of HIV testing and linkage to care remains low among men, contributing to continued high HIV incidence in women and HIV-related mortality in men in South Africa. Methods: The “Home-Based Trial to Test and Start” (HITS) is a cluster- randomized controlled trial of 45 communities (clusters) in the Umkhanyakude district of KwaZulu-Natal (ClinicalTrials.gov # NCT03757104). It is based in the Africa Health Research Institute (AHRI)’s population-based HIV testing platform, which offers home-based rapid HIV testing to all adults. In a 2x2 factorial design, we randomly assigned all men aged ≥15 years living in the 45 clusters to one of four arms: (i) a financial micro-incentive for HIV testing (R50 [$3] food voucher) (n=8), (ii) male-targeted counseling (n=8), (iii) both the micro-incentive and male-targeted counseling (n=8), and (iv) standard of care (SoC). The male-targeted counseling application, called EPIC-HIV, was a tablet-delivered theoretically-informed application, developed iteratively, to encourage HIV testing and individually offered to men. Here we report the effect of the interventions on the first registered primary endpoint of the HITS trial: uptake of home-based HIV testing among men. Intention-to-treat (ITT) analysis was performed using modified Poisson regression with adjustment for clustering of standard errors at the cluster level. Results: Among all men ≥15 years living in the 45 communities who were eligible for HIV testing based on registration in AHRI’s population-based HIV testing in 2018 (n=13,838), HIV testing uptake was 28% (683/2481) in the micro-incentive arm, 17% (433/2534) in the EPIC arm, 27% (568/2120) in the arm receiving both interventions, and 18% in the SoC arm. The HIV testing uptake among those men who could be located and approached for testing was 68% (micro-incentive), 56% (EPIC-HIV), 70% (both interventions), and 52% (SoC). In ITT analysis, compared to men in the SoC arm, the probability of HIV testing was 55% higher in the micro-incentive only arm (risk ratio (RR)=1.55, 95% CI: 1.31-1.82, p<0.001) and 50% higher in the armwith both interventions (RR=1.50, 95% CI: 1.21-1.87, p<0.001). The probability of HIV testing was not

53LB POINT-OF-CARE VIRAL LOAD TESTING IMPROVES HIV VIRAL SUPPRESSION AND RETENTION IN CARE

Paul K. Drain 1 , Jienchi Dorward 2 , Lauren Violette 1 , Justice Quame-Amaglo 1 , Katherine Thomas 1 , Natasha Samsunder 3 , Hope Ngobese 3 , Koleka Mlisana 3 , Pravi Moodley 3 , Deborah J. Donnell 1 , Ruanne V. Barnabas 1 , Kogieleum Naidoo 3 , Salim Abdool Karim 3 , Connie L. Celum 1 , Nigel Garrett 3 1 University of Washington, Seattle, WA, USA, 2 University of Oxford, Oxford, UK, 3 University of KwaZulu-Natal, Durban, South Africa Background: Achieving the 90-90-90 targets will require efficient methods to monitor people living with HIV (PLHIV) on antiretroviral therapy (ART) in resource-limited settings. We compared point-of-care (POC) viral load (VL) testing to standard laboratory VL testing for achieving VL suppression and retention in care for PLHIV in Durban, South Africa. Methods: We conducted an open-label, randomized controlled trial among adults (≥18 years) enrolled 6 months after ART initiation at an urban public clinic. Participants were randomized to receive either POC VL testing (Xpert® HIV-1 VL, Cepheid) and same day counseling or standard-of-care (SOC) laboratory VL testing. All participants were followed for 12 months and received HIV care according to South African guidelines, including clinic visits every 2 months, VL testing at month 6 and 12 after ART initiation, and consideration for decentralized ART delivery at community pharmacies 1 year after ART initiation. The primary outcome was retained with VL suppression (<200 copies/mL) after 12 months, with retained defined as collecting ART at the study clinic between 44-56 weeks after enrollment. Those not retained were contacted for follow-up VL testing. Results: Among 390 participants, mean age was 33 years, 235 (60%) were female, and median CD4 count at enrollment was 468 [IQR 309-666] cells/mm3. After 12 months, 175 (89.7%) participants in the POC arm and 148 (75.9%) in the SOC armwere retained with VL suppression, an increase of 13.9% (95% CI 6.4- 21.2, p=0.0004) among participants who received POC VL testing compared to those who received laboratory VL testing (Table). When disaggregated, POC VL testing increased VL suppression by 10.3% from 83.1% to 93.3% (p=0.003) and increased retention by 7.7% from 84.6% to 92.3% (p=0.03). When restricted to those with a VL result at exit, the proportion with VL suppression increased by 5.3% from 91.0% to 96.3% (p=0.05) in the POC arm. During the study, 99.5% of POC arm participants received the VL result on the same day, while 74.7% of SOC participants received a VL result a median of 41 [IQR 28-69] days after blood

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CROI 2019